What happens in the bronchi
The inside of the bronchi is lined with cells with cilia, which constantly remove mucus to the outside. With prolonged or severe inflammation, this mechanism is damaged, the bronchial wall loses its elasticity and stretches. In pouch-like expansions, mucus is not removed and becomes a breeding ground for bacteria. Chronic infection maintains inflammation, further destroys the wall and involves surrounding lung tissue. Over time, part of the lung ceases to participate in breathing, and shortness of breath appears. The process is usually localized in the lower lobes, but can be widespread.
- Damage to eyelashes and mucus buildup
- Expansion and deformation of the bronchi
- Constant bacterial colonization
- Destruction of the bronchial wall by inflammation
- Decreased participation of part of the lung in breathing
Reasons
Some cases begin in childhood: severe pneumonia, whooping cough, measles or foreign body aspiration damage the bronchus, and the expansion forms gradually. In adults, past tuberculosis, chronic lung diseases, and prolonged inhalation of irritating substances are important. A separate group consists of hereditary and systemic conditions: cystic fibrosis, primary ciliary dyskinesia, immune deficiencies, rheumatoid arthritis, inflammatory bowel diseases. Finding the cause is important because in some cases it can be treated separately.
- Past severe pneumonia, whooping cough, measles
- Pulmonary tuberculosis
- Cystic fibrosis
- Primary ciliary dyskinesia
- Immunodeficiencies
- Foreign body aspiration
- Chronic obstructive pulmonary disease, smoking
Symptoms
The leading symptom is a daily cough with sputum, which a person often considers to be his norm. Sputum comes out more easily in the morning and when changing body position, its amount can be significant, the color can be from light to greenish. Exacerbations occur periodically: fever, weakness, increased cough, purulent sputum, and sometimes streaks of blood. Over time, shortness of breath on exertion, weight loss, and sinusitis develop. A characteristic, but not obligatory sign of a long-term disease is thickening of the terminal phalanges of the fingers.
- Daily cough with phlegm, especially in the morning
- Purulent sputum during exacerbation
- Repeated bronchitis and pneumonia
- Hemoptysis, often not profuse
- Shortness of breath on exertion
- Weakness, weight loss
- Chronic sinusitis
Diagnostics
A regular X-ray often does not show bronchiectasis, so the main method is high-resolution computed tomography: it sees the dilated bronchi, their shape and extent. Sputum culture is required to determine sensitivity to antibiotics in order to provide targeted treatment in case of exacerbation. Spirometry assesses the degree of airway obstruction. Next, they look for the cause: they examine immunity indicators, rule out tuberculosis, and if cystic fibrosis is suspected, special tests are performed. For local lesions, bronchoscopy is considered.
- High resolution chest CT
- Sputum culture with antibiogram
- Spirometry
- Complete blood count, C-reactive protein
- Exclusion of tuberculosis
- Assessment of immune status
- Bronchoscopy according to indications
Treatment
The core of treatment is daily cleansing of the bronchi. Breathing exercises, special body positions to drain mucus, coughing using techniques taught by your doctor, and drinking enough fluids work better than any pill. Sputum thinners and inhalations are used as prescribed. Antibiotics are used for exacerbations and are selected based on culture results, and not on the principle of “what helped your neighbor”; uncontrolled use leads to bacterial resistance. Annual flu and pneumococcal vaccinations, smoking cessation, sinusitis treatment, and good nutrition are important. In case of limited damage with frequent exacerbations, surgical removal of a section of the lung is discussed.
- Daily bronchial drainage and breathing exercises
- Teaching coughing techniques
- Inhalations and mucolytics as prescribed
- Antibiotics for exacerbation based on culture results
- Vaccination against influenza and pneumococcus
- Quitting smoking, treating foci of infection
- Physical activity and good nutrition
- Surgical treatment for local lesions